RGHS, Excellus and GRIPA reach five-year agreement

Rochester General Health System and its affiliated doctors group, the Greater Rochester Independent Practice Association Inc., have finalized a five-year contract with Excellus BlueCross BlueShield that officials predict will change the shape of local health care.

The pact promises extra cash to GRIPA doctors who follow protocols designed to improve patients’ health and slow increases in health care costs. RGHS CEO Mark Clement said it has been in the works since last fall when he and Excellus CEO Christopher Booth shook hands on an agreement.

The contract has been in effect as a working agreement since Jan. 1 but was adopted formally after Excellus, RGHS and GRIPA settled the final details some three weeks ago, Clement said.

Some 110,000 Excellus-insured patients of GRIPA physicians are initially covered but the pool of subscribers could increase as GRIPA, which is actively recruiting primary care physicians, adds new members, GRIPA CEO Joseph Vasile M.D. said.

RGHS and GRIPA are negotiating with Schenectady-based MVP Health Care in hope of striking a similar deal, Clement said.

The deal creates a provider organization structured along lines laid out in the Patient Protection and Affordable Care Act and in new rules being promulgated by the Centers for Medicare and Medicaid Services.

Accountable care organizations or accountable care networks are supposed to improve the quality of care while cutting costs. To hold such organizations accountable, the still-evolving rules call for provider payments to be linked to quality metrics.

RGHS and GRIPA might apply for federal designation as a Medicare ACO in 2014, Clement said.

"Health care will not continue as it always has,” Excellus CEO Christopher Booth said. “Rochester has consistently been at the forefront of innovation in health care, and this agreement is another way our community is stepping up to lead the way. We are excited to collaborate and invest in this proactive approach.”

For more on the agreement see the June 14 edition of the Rochester Business Journal.